Provider Demographics
NPI:1659793396
Name:JARED A FRANSON, DMD, PS
Entity Type:Organization
Organization Name:JARED A FRANSON, DMD, PS
Other - Org Name:APPLE DENTAL, FRANSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKINLAY
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, CTA
Authorized Official - Phone:208-724-2257
Mailing Address - Street 1:2020 9TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4072
Mailing Address - Country:US
Mailing Address - Phone:360-423-0290
Mailing Address - Fax:360-423-5596
Practice Address - Street 1:2020 9TH AVE STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4072
Practice Address - Country:US
Practice Address - Phone:360-423-0290
Practice Address - Fax:360-423-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306993340OtherINDIVIDUAL NPI